By itself, the amount of indigent care provided by nonprofit hospitals and other nonprofit health care entities does not justify their tax exemptions, but these institutions often provide other, less easily measured benefits that vary from service to service and from community to community. "Thus, restricting the rationale for tax exemption to indigent care, as done in some states and favored by some policy analysts, is a misguided approach to improving community health," say Mark Schlesinger and Bradford Gray in the lead article of a four-paper package on nonprofits published June 20 on the Health Affairs Web site.

Over the past few years, health plans of all types - even HMOs -- have focused product development on "consumer-directed" plans with high deductibles, often accompanied by tax-favored health spending accounts or health reimbursement arrangements. However, say researchers from the Center for Studying Health System Change in the May/June Health Affairs, employer response has been cautious: For example, only 12 employers in Little Rock, Arkansas, chose to offer consumer-directed plans in 2005. Large firms were supportive of these plans, but employee take-up rates for consumer-directed plans ranged from 2 to 35 percent and were typically under 15 percent.

"The growing influence of consumer/survivor perspectives has largely been a consequence, not a cause, of radical restructurings of the mental health field," Nancy Tomes reports in the May/June Health Affairs. Tomes says that "consumer perspectives entered policy discourse in the wake of policy failures"; for example, in the 1970s, a failure to fund and coordinate medical and social services for deinstitutionalized people with mental illness rendered self-help "a strategy that was critical to consumer survival." Consumer perspectives have continued to flourish "in a climate of perpetual crisis and tight budgets," Tomes adds.